Associations between adverse childhood experiences and history of weight cycling.

Background: Adverse childhood experiences (ACEs) predict obesity onset; however, the relationship between ACEs and history of weight cycling has not been adequately explored. This gap is problematic given the difficulty in weight loss maintenance and the impact of ACEs on obesity development, chronicity, and associated weight stigma. The objective of this study was to examine associations between self-reported history of ACEs and weight cycling in a sample of weight loss treatment-seeking adults with overweight/obesity. Methods: The number of participants in the analyzed sample was 78, mostly white educated adult women (80% female, 81% Caucasian, 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self-regulatory Mechanisms of Obesity Study. ACEs were measured at baseline using the ACEs Scale. History of weight cycling was measured using the Weight and Lifestyle Inventory that documented weight loss(es) of 10 or more pounds. Results: Higher ACE scores were associated with a greater likelihood of reporting a history of weight cycling. Participants with four or more ACEs had 8 times higher odds (OR = 8.301, 95% CI = 2.271-54.209, p = 0.027) of reporting weight cycling compared with participants with no ACEs. The association of weight cycling for those who endorsed one to three ACEs was not significant (OR = 2.3, 95% CI = 0.771-6.857, p = 0.135) in this sample. Conclusions: The role of ACEs in health may be related to associations with weight cycling. Results indicated that those who reported four or more ACEs had significantly higher odds of reporting weight cycling compared with those with no ACEs. Further research is needed to further explore how ACEs predict the likelihood of weight cycling, which may be prognostic for sustained weight loss treatment response and weight stigma impacts.

Hoosier Sport: a research protocol for a multilevel physical activity-based intervention in rural Indiana.

Introduction: Currently, only 1 in 4 children in the U.S. engage in the recommended amount of physical activity (PA) and disparities in PA participation increase as income inequities increase. Moreover, leading health organizations have identified rural health as a critical area of need for programming, research, and policy. Thus, there is a critical need for the development and testing of evidence-based PA interventions that have the potential to be scalable to improve health disparities in children from under-resourced rural backgrounds. As such, the present study utilizes human-centered design, a technique that puts community stakeholders at the center of the intervention development process, to increase our specific understanding about how the PA-based needs of children from rural communities manifest themselves in context, at the level of detail needed to make intervention design decisions. The present study connects the first two stages of the NIH Stage Model for Behavioral Intervention Development with a promising conceptual foundation and potentially sustainable college student mentor implementation strategy. Methods: We will conduct a three-phase study utilizing human-centered community-based participatory research (CBPR) in three aims: (Aim 1) conduct a CBPR needs assessment with middle school students, parents, and teachers/administrators to identify perceptions, attributes, barriers, and facilitators of PA that are responsive to the community context and preferences; (Aim 2) co-design with children and adults to develop a prototype multi-level PA intervention protocol called Hoosier Sport; (Aim 3) assess Hoosier Sport's trial- and intervention-related feasibility indicators. The conceptual foundation of this study is built on three complementary theoretical elements: (1) Basic Psychological Needs mini-theory within Self-Determination Theory; (2) the Biopsychosocial Model; and (3) the multilevel Research Framework from the National Institute on Minority Health and Health Disparities. Discussion: Our CBPR protocol takes a human-centered approach to integrating the first two stages of the NIH Stage Model with a potentially sustainable college student mentor implementation strategy. This multidisciplinary approach can be used by researchers pursuing multilevel PA-based intervention development for children.

"It Has a Lot to Do With the Cumbersome Paperwork": Barriers and Facilitators of Center-Based Early Care and Education Program Participation in the Child and Adult Care Food Program.

BACKGROUND: The Child and Adult Care Food Program (CACFP) is a federally regulated feeding program that reimburses early care and education (ECE) programs for providing nutritious meals to low-income children. Participation in CACFP is voluntary and varies widely across states. OBJECTIVE: This study assessed barriers and facilitators of center-based ECE program participation in CACFP and identified potential strategies to promote the participation of eligible programs. DESIGN: This was a multimethod (eg, interviews, surveys, and document reviews) descriptive study. PARTICIPANTS/SETTING: Participants included stakeholders from 22 national and state agencies that work with ECE programs to promote CACFP, nutrition, and quality care; representatives of 17 sponsor organizations; and 140 center-based ECE program directors from Arizona, North Carolina, New York, and Texas. STATISTICAL ANALYSES PERFORMED: Barriers, facilitators, and recommended strategies to promote CACFP that emerged from interviews were summarized with relevant illustrative quotes. Survey data were analyzed descriptively using frequencies and percentages. RESULTS: Key barriers to center-based ECE program participation in CACFP shared by participants included the cumbersome CACFP paperwork, difficulty meeting eligibility requirements, strict meal patterns, difficulties with meal counts, penalties for noncompliance, low reimbursements, inadequate ECE staff to assist with paperwork, and limited trainings. Facilitators to participation included supports provided by stakeholders and sponsors through outreach, technical assistance, and nutrition education. Potential strategies recommended to promote CACFP participation would require policy change (eg, streamlining paperwork, modifying eligibility requirements, and leniency toward noncompliance) and systems-level change (eg, more outreach and technical assistance) by stakeholders and sponsor organizations. CONCLUSIONS: Stakeholder agencies recognized the need to prioritize CACFP participation and highlighted ongoing efforts. Policy changes are needed at the national and state levels to address barriers and ensure consistent CACFP practices among stakeholders, sponsors, and ECE programs.

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities.

BACKGROUND: Obesity levels are higher in rural versus urban children. Multi-level community-based interventions can be effective in promoting healthy child weight, but few of such interventions have focused on rural children. This formative study assessed barriers, facilitators, and opportunities to promote healthy child weight in two rural communities. METHODS: Multiple data collection methods were used concurrently in two rural communities in Indiana and North Carolina. Focus groups and interviews were conducted with participants, including parents of children aged 2-5 years (n = 41), childcare providers (n = 13), and stakeholders from 23 community organizations. Observational audits were conducted at 19 food outlets (grocery stores) and 50 publicly-accessible physical activity resources. Focus groups/interviews were analyzed thematically. Surveys were analyzed using descriptive statistics, Fisher's exact test, and t-tests. RESULTS: Family level barriers included limited financial resources and competing priorities, whereas parental role-modeling was perceived as a facilitator of healthy weight behaviors. At the organizational level, childcare providers and community stakeholders cited limited funding and poor parental engagement in health promotion programs as barriers. Childcare providers explained that they were required to comply with strict nutrition and physical activity guidelines, but expressed concerns that similar messages were not reinforced at home. Facilitators at the organizational level included healthy meals provided at no cost at childcare programs, and health promotion programs offered through community organizations. At the community level, lack of public transportation, and limited access to healthy food outlets and physical activity-promoting resources posed barriers, whereas existing physical activity resources (e.g., parks) and some ongoing investment to improve physical activity resources in the community were assets. In designing/implementing a potential child obesity prevention intervention, participants discussed the need to garner community trust, emphasize wellness instead of obesity prevention, establish community partnerships, and leverage existing community resources. CONCLUSIONS: Rural areas experience multiple challenges that make it difficult for children/families to engage in healthy weight behaviors. This study highlights several assets (existing programs/resources, expertise within communities) that can be leveraged as facilitators. Findings will guide the study team in developing a child obesity prevention intervention for the two rural communities.

Experiences pertaining to child nutrition and care provision among early care and education stakeholders, sponsors, and center directors during the COVID-19 pandemic: A multi-method study.

Purpose: This study used multiple methods (interviews, survey) to assess experiences of stakeholders, sponsors, and center-based early care and education (ECE) program directors pertaining to child nutrition (e.g., provision of nutritious foods, mealtime practices, CACFP administration/use) and the provision of child-care (i.e., day-to-day ECE operations and programming) during the COVID-19 pandemic. Methods: Participants included stakeholders from 22 national and state agencies associated with the Child and Adult Care Food Program (CACFP) who also work to promote nutrition and quality child-care, representatives of 17 CACFP sponsor organizations, and 40 center-based ECE program directors who participated in interviews, as well as 100 ECE directors who completed surveys. Data were collected across four states. Thematic analyses of interviews and descriptive methods were used to analyze data collected. Results: Six main themes emerged from stakeholders, sponsors, and ECE program directors' focusing on: experiences during the temporary closure of several ECE programs; additional responsibilities and unanticipated expenses for ECE programs; difficulty in keeping up with constantly changing COVID-19 guidance; encounters during shifts from in-person to virtual training and monitoring; changes to nutrition practices at ECE; and the need to prioritize ECE funding. Conclusions: Findings highlight challenges and supports to ECE programs and could inform future efforts to enhance child-care quality and child nutrition in the U.S. during pandemic situations.

Facilitators and barriers to family child care home participation in the U.S. Child and Adult Care Food Program (CACFP).

This paper describes facilitators, barriers, and potential strategies to promote participation in the Child and Adult Care Food Program (CACFP) by family child care homes (FCCHs). This descriptive study occurred from January-May 2022 in Arizona and New York, two states with varying levels of CACFP participation. Stakeholders from three state-level CACFP-administering agencies, representatives of six sponsor organizations, and 23 FCCH providers (70% CACFP, 30% non-CACFP) participated in interviews. Facilitators of CACFP participation included the simple enrollment, technical assistance from sponsors, software provided by sponsors, and incentives from state agencies. Barriers included perceptions that CACFP paperwork would be burdensome, lack of access to sponsors, and challenges with meal pattern requirements. Recommended strategies to promote CACFP uptake included educating providers about CACFP, expanding outreach, and additional funding. Efforts to address state-level disparities in FCCH participation in CACFP are needed. This study provides some insight into policy and systems changes that could be beneficial.

Food Outlet Density, Distance, and Food Quality Offered to Preschool-Aged Children at Family Child Care Homes.

OBJECTIVE: To examine how food environments around family child care homes (FCCHs) are associated with the healthfulness of foods served to children. DESIGN: Cross-sectional data from a mail survey of FCCH providers, InfoUSA. PARTICIPANTS: The study included 132 Mississippi FCCHs (26% response). MAIN OUTCOME MEASURES: Dependent: compliance with nutrition best practices for 9 food categories; composite healthfulness score. Independent: counts of supermarkets, small-medium grocery stores, produce stores, convenience stores within 5 miles; distance to supermarket. ANALYSIS: Logistic regression estimated associations between best-practice compliance and food environment. Linear regression estimated associations between composite food healthfulness and food environment. Models stratified by rural/urban location. RESULTS: Rural FCCHs with higher counts of supermarkets, convenience stores, and produce stores had lower compliance with selected best practices (fried/prefried potatoes, high-sugar/high-fat foods). Urban FCCHs with more supermarkets had higher compliance with fruit not canned in syrup; those with more small-medium grocery stores and convenience stores had lower compliance with selected best practices (fried/prefried potatoes, vegetables, low-fat meats). CONCLUSIONS AND IMPLICATIONS: Food environment measures were associated with some nutrition best practices, though not consistently in the expected direction. Future research could examine food quality at stores near rural FCCHs. Programs that improve local food environments may improve foods served at FCCHs.

Lessons From the Feasibility Testing of a Parent-Focused, Life Skills-Based Intervention to Prevent Obesity in Preschoolers From Underserved Families.

This article describes lessons from the feasibility testing of a parent-focused, life skills-based intervention to promote healthy weight in 58 low-income children aged 2 to 5 years. This intervention was feasible and acceptable, with a potential to impact child weight and diet (calories) and parental quality of life (QOL). The group delivery approach through a partnering organization (Head Start) was a more efficient way to reach/engage parents. Compared with one-on-one sessions, the group could provide an avenue to enhance parental psychosocial well-being, given QOL improvements among parents in group sessions. Lessons will inform future research to test the effectiveness of life skills interventions.

The Quality of Nutrition and Physical Activity Environments of Family Child-Care Homes in a State in the Southern United States.

BACKGROUND: Family child-care homes (FCCHs) are an important provider of nonparental child care for low-income families. Little is known about the quality of nutrition and physical activity environments of FCCHs in the southern United States, where child obesity and child poverty levels are high. OBJECTIVES: To assess the quality of the nutrition and physical activity environments of a sample of FCCHs in Mississippi and examine the differences by urban vs rural location. DESIGN: Cross-sectional study. PARTICIPANTS/SETTING: Data were from a random sample of 134 FCCHs that enroll children aged 3 to 5 years. The sample was stratified by urban vs rural location and participation in the Child and Adult Care Food Program. Providers completed a modified version of the Environment and Policy Assessment and Observation-Self Report tool by mail and reported on provisions, practices, policies, and the general FCCH nutrition and physical activity environment. MAIN OUTCOME MEASURES: A nutrition environment score (range=0 to18), physical activity environment score (range=0 to 24), and a combined nutrition and physical activity environment score (range=0 to 42) were calculated from Environment and Policy Assessment and Observation-Self Report tool data. STATISTICAL ANALYSES PERFORMED: Descriptive statistics and t tests were computed, with statistical significance set at P≤0.05. RESULTS: Average scores for the nutrition, physical activity, and combined nutrition and physical activity environment were 9.4, 11.1, and 20.5, respectively. The average nutrition environment score (9.6 vs 9.2; P=0.39) and physical activity environment score (11.3 vs 11.0; P=0.62) did not differ between urban and rural homes. The combined nutrition and physical activity scores (20.8 vs 20.2; P=0.50) also did not differ between urban and rural homes. CONCLUSIONS: Findings highlight the need to improve the nutrition and physical activity environments of FCCHs, regardless of geographic location. Further research is needed to understand barriers to providing higher-quality nutrition and physical activity environments.

The quality of nutrition and physical activity environments of child-care centers across three states in the southern U.S.

This cross-sectional study assessed the quality of nutrition and physical activity environments of child-care centers in three southern states and examined differences by rural versus urban location, participation in the Child and Adult Care Food Program, and Head Start status. The sample included 354 centers that enroll children aged 2-5: 154 centers from Georgia, 103 from Kentucky, and 97 centers from Mississippi. Directors and 1-2 teachers per center completed the Environment and Policy Assessment and Observation Self-Report (EPAO-SR) tool that assesses nutrition and physical activity environments of child-care centers. The EPAO-SR items were scored to capture six nutrition domains and six physical activity domains that were averaged and then summed to create a combined nutrition and physical activity environment score (range = 0-36); higher scores indicated that centers met more best practices, which translated to higher-quality environments. Overall, the centers had an average combined nutrition and physical activity environment score of 20.2 out of 36. The scores did not differ between rural and urban centers (mean = 20.3 versus 20.2, p = 0.98). Centers in the Child and Adult Care Food Program had higher combined nutrition and physical activity environment scores than non-participating centers (mean = 20.6 versus 19.1, p < 0.01). Head Start centers also had higher combined environment scores than non-Head Start centers (mean = 22.3 versus 19.6, p < 0.01). Findings highlight the vital role of federal programs in supporting healthy child-care environments. Providing technical assistance and training to centers that are not enrolled in well-regulated, federally-funded programs might help to enhance the quality of their nutrition and physical activity environments.

Participation in the Child and Adult Care Food Program Is Associated with Healthier Nutrition Environments at Family Child Care Homes in Mississippi.

OBJECTIVE: Describe foods and beverages offered, nutrition practices, and nutrition policies of family child care homes in Mississippi and differences by participation in the Child and Adult Care Food Program (CACFP). DESIGN: Cross-sectional study conducted between fall, 2015 and spring, 2016. SETTING: Mississippi. PARTICIPANTS: Random, stratified sample of 134 family child care homes that enroll 3- to 5-year-olds. Providers completed a modified version of the Environment and Policy Assessment and Observation-self-report tool. VARIABLES MEASURED: Foods and beverages offered at lunch, provider practices regarding nutrition, and presence or absence of written nutrition policies. ANALYSIS: Descriptive statistics, likelihood ratio chi-square, and t tests. RESULTS: Most homes (>75%) provided components from the fruit, vegetable, grain/bread, meat/meat alternative, and milk food groups at lunch. At some homes, the food and beverage selections offered were high in fat, sugar, and refined grains. Providers at CACFP-participating homes (P < .05) reported healthier beverage selections, more healthful nutrition practices, and more written nutrition policies compared with providers at non-CACFP homes. CONCLUSION AND IMPLICATIONS: Interventions and regulatory standards are needed, particularly in non-CACFP homes, to ensure that food and beverage offerings, provider practices, and policies regarding nutrition support the development of healthful dietary behaviors in early childhood.

Assessing Challenges in Low-Income Families to Inform a Life Skills-Based Obesity Intervention.

BACKGROUND: This article describes the formative research undertaken to explore challenges of low-income parents of 3-to 5-year-olds to inform a parent-focused life skills-based intervention to prevent obesity in preschool-aged children. METHOD: A total of 40 parents completed surveys, 30 parents participated in focus groups, and 5 community stakeholders participated in individual interviews. In each data mode, participants were asked to prioritize a list of challenges centered on parenting, family care, and self-care. Survey data were analyzed descriptively using SAS, while focus groups and interviews were analyzed for emerging themes using ATLAS.ti. RESULTS: Parents reported needing strategies for managing children's behavior around picky eating, limits/boundaries, tantrums, and routines. Challenges with child behavior management were compounded by parents' inability to find affordable fun family activities outside the home and difficulties in communicating childrearing expectations to coparents/relatives who assisted with child care. Added to these were other competing priorities (e.g., financial) that led to the neglect of self, including the inability to find "me" time, build relationships, and care for one's health. CONCLUSIONS: Interventions that address parenting, family care and self-care challenges of low-income parents may enhance resilience and support positive changes that can promote healthy development in children, including obesity prevention.

Family child care home providers as role models for children: Cause for concern?

Health behaviors associated with chronic disease, particularly healthy eating and regular physical activity, are important role modeling opportunities for individuals working in child care programs. Prior studies have not explored these risk factors in family child care home (FCCH) providers which care for vulnerable and at-risk populations. To address this gap, we describe the socio-demographic and health risk behavior profiles in a sample of providers (n = 166 FCCH) taken from baseline data of an ongoing cluster-randomized controlled intervention (2011-2016) in North Carolina. Data were collected during on-site visits where providers completed self-administered questionnaires (socio-demographics, physical activity, fruit and vegetable consumption, number of hours of sleep per night and perceived stress) and had their height and weight measured. A risk score (range: 0-6; 0 no risk to 6 high risk) was calculated based on how many of the following were present: not having health insurance, being overweight/obese, not meeting physical activity, fruit and vegetable, and sleep recommendations, and having high stress. Mean and frequency distributions of participant and FCCH characteristics were calculated. Close to one third (29.3%) of providers reported not having health insurance. Almost all providers (89.8%) were overweight or obese with approximately half not meeting guidelines for physical activity, fruit and vegetable consumption, and sleep. Over half reported a "high" stress score. The mean risk score was 3.39 (± 1.2), with close to half of the providers having a risk score of 4, 5 or 6 (45.7%). These results stress the need to promote the health of these important care providers.

Impact of Policies on Physical Activity and Screen Time Practices in 50 Child-Care Centers in North Carolina.

BACKGROUND: This study assessed physical activity and screen time policies in child-care centers and their associations with physical activity and screen time practices and preschool children's (3-5 years old) physical activity. METHODS: Data were from 50 child-care centers in North Carolina. Center directors reported on the presence/absence of written policies. Trained research assistants observed physical activity and screen time practices in at least 1 preschool classroom across 3 to 4 days. Children (N = 544) wore accelerometers to provide an objective measure of physical activity. RESULTS: Physical activity and screen time policies varied across centers. Observational data showed 82.7 min/d of active play opportunities were provided to children. Screen time provided did not exceed 30 min/d/child at 98% of centers. Accelerometer data showed children spent 38 min/d in moderate-to-vigorous physical activity and 206 min/d in sedentary activity. Policies about staff supervision of media use were negatively associated with screen time (P < .05). Contrary to expectation, policies about physical activity were associated with less time in physical activity. CONCLUSIONS: Clear strategies are needed for translating physical activity policies to practice. Further research is needed to evaluate the quality of physical activity policies, their impact on practice, and ease of operationalization.

Development and implementation of the National Cancer Institute's Food Attitudes and Behaviors Survey to assess correlates of fruit and vegetable intake in adults.

BACKGROUND: Low fruit and vegetable (FV) intake is a leading risk factor for chronic disease globally as well as in the United States. Much of the population does not consume the recommended servings of FV daily. This paper describes the development of psychosocial measures of FV intake for inclusion in the U.S. National Cancer Institute's 2007 Food Attitudes and Behaviors Survey. METHODS: This was a cross-sectional study among 3,397 adults from the United States. Scales included conventional constructs shown to be correlated with fruit and vegetable intake (FVI) in prior studies (e.g., self-efficacy, social support), and novel constructs that have been measured in few- to- no studies (e.g., views on vegetarianism, neophobia). FVI was assessed with an eight-item screener. Exploratory factor analysis, Cronbach's alpha, and regression analyses were conducted. RESULTS: Psychosocial scales with Cronbach's alpha ≥0.68 were self-efficacy, social support, perceived barriers and benefits of eating FVs, views on vegetarianism, autonomous and controlled motivation, and preference for FVs. Conventional scales that were associated (p<0.05) with FVI were self-efficacy, social support, and perceived barriers to eating FVs. Novel scales that were associated (p<0.05) with FVI were autonomous motivation, and preference for vegetables. Other single items that were associated (p<0.05) with FVI included knowledge of FV recommendations, FVI "while growing up", and daily water consumption. CONCLUSION: These findings may inform future behavioral interventions as well as further exploration of other potential factors to promote and support FVI.

Cross-sectional examination of physical and social contexts of episodes of eating and drinking in a national sample of US adults.

OBJECTIVE: The current study characterizes associations between physical and social contexts of self-reported primary episodes of eating/drinking and sociodemographic and obesity-related variables in US adults. DESIGN: Multinomial logistic regression was used to analyse a nationally representative sample of adults from the 2006-2008 American Time Use Survey. Models identifying physical (where) and social (whom) contexts of primary eating/drinking episodes at the population level, controlling for demographic characteristics, weight status and time of eating, were conducted. SETTING USA SUBJECTS: A nationally representative sample of US adults (n 21 315). RESULTS: Eating/drinking with immediate family was positively associated with age (OR = 1·15 (95 % CI 1·04, 1·27) to 1·23 (95 % CI 1·09, 1·39)), education level (OR = 1·16 (95 % CI 1·03, 1·30) to 1·36 (95 % CI 1·21, 1·54)), obesity (OR = 1·13 (95 % CI 1·04, 1·22)), children in the household (OR = 3·39 (95 % CI 3·14, 3·66)) and time of day (OR = 1·70 (95 % CI 1·39, 2·07) to 5·73 (95 % CI 4·70, 6·99)). Eating in the workplace was negatively associated with female gender (OR = 0·65 (95 % CI 0·60, 0·70)) and children in the household (OR = 0·90 (95 % CI 0·83, 0·98)), while positively associated with non-white status (OR = 1·14 (95 % CI 1·01, 1·29) to 1·47 (95 % CI 1·32, 1·65)) and time of day (OR = 0·25 (95 % CI 0·28, 0·30) to 5·65 (95 % CI 4·66, 6·85)). Women (OR = 0·80 (95 % CI 0·74, 0·86)), those aged >34 years (OR = 0·48 (95 % CI 0·43, 0·54) to 0·83 (95 % CI 0·74, 0·93)) and respondents with children (OR = 0·69 (95 % CI 0·63, 0·75)) were less likely to eat in a restaurant/bar/retail than at home. Overweight and obese respondents had a greater odds of reporting an episode of eating in social situations v. alone (e.g. immediate family and extended family; OR = 1·13 (95 % CI 1·04, 1·22)) and episodes occurring in restaurant/bar/retail locations (OR = 1·12 (95 % CI 1·03, 1·23) to 1·14 (95 % CI 1·05, 1·24)). CONCLUSIONS: Findings underscore the multidimensional nature of describing eating/drinking episodes. Social and physical contexts for eating/drinking and their demographic correlates suggest opportunities for tailoring interventions related to diet and may inform intervention targeting and scope.

Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005.

The Healthy Eating Index-2005 (HEI-2005) has been applied primarily to assess the quality of individual-level diets but has recently been applied to environmental-level data as well. Currently, no studies have applied the HEI-2005 to foods offered in child-care settings. This cross-sectional study used the HEI-2005 to assess the quality of foods and beverages offered to preschool children (3 to 5 years old) in child-care centers. Two days of dietary observations were conducted and 120 children (six children per center) were observed at 20 child-care centers in North Carolina between July 2005 and January 2006. Data were analyzed between July 2011 and January 2012 using t tests. Mean total HEI-2005 score (59.12) was significantly (P<0.01) lower than the optimal score of 100, indicating the need to improve the quality of foods offered to children. All centers met the maximum score for milk. A majority also met the maximum scores for total fruit (17 of 20 centers), whole fruit (15 of 20 centers), and sodium (19 of 20 centers). Mean scores for total vegetable (mean=2.26±1.09), dark green/orange vegetables and legumes (mean=0.20±0.43), total grain (mean=1.09±1.25), whole grain (mean=1.29±1.65), oils (mean=0.44±0.25), and meat/beans (mean=0.44±0.25) were significantly lower than the maximum scores recommended (P<0.01). Mean scores for saturated fat (mean=3.32±3.41; P<0.01) and calories from solid fats and added sugars (mean=14.76±4.08; P<0.01) suggest the need to decrease the provision of foods high in these components. These findings indicate the need to improve the quality of foods offered to children at the centers to ensure that the foods provided contribute to children's daily nutrition requirements.

Caregiver food behaviours are associated with dietary intakes of children outside the child-care setting.

OBJECTIVE: To evaluate whether food behaviours of parents are associated with children's dietary intakes outside the child-care setting, and to compare children's dietary intakes at home with foods and beverages consumed when they are at child-care centres. DESIGN: In 2005­2006, a survey was completed by parents of at least one child between 3 and 5 years old who attended group child-care centres. Surveys about nutrition practices were completed by centre directors. Research assistants observed foods and beverages consumed by children at lunchtime at the centres. SETTING: Sixteen licensed group child-care centres in three underserved New York City communities (South Bronx, East/Central Harlem, Central Brooklyn) and the Lower East Side of Manhattan. SUBJECTS: Two hundred parents. RESULTS: Children were more likely to consume healthful foods including fruits or vegetables if parents reported purchasing food from produce stands/farmers' markets, shopped for frozen or canned fruits frequently and ate family meals or meals prepared at home daily. Children were more likely to consume less healthful foods such as French fries, or fruit drinks, more frequently if parents reported eating meals from fast-food or other restaurants at least once weekly, or if children ate while watching television. Types of foods and beverages offered to children at home (e.g. higher-fat milk, soft drinks and desserts) were less healthful than those offered at child-care centres. CONCLUSIONS: Children's dietary intakes at home need to be improved. Parents need to understand the importance of providing home environments that support healthful food behaviours in children.

Nutrition policies at child-care centers and impact on role modeling of healthy eating behaviors of caregivers.

Studies suggest that caregivers influence children's dietary behaviors through role modeling in child-care environments. However, few studies have examined role modeling by caregivers and child-care center policies. This cross-sectional study evaluated the associations between child-care center policies about staff eating practices and caregivers' eating behaviors during mealtime interactions with children. Data were collected in 2008-2009 at 50 North Carolina child-care centers. Caregivers (n=124) reported about modeling healthy eating behaviors to children, trained research staff observed caregivers' (n=112) eating behaviors in classrooms, and directors reported about the presence/absence of center policies on staff eating practices. About 90% of caregivers reported modeling healthy eating behaviors to children. At 80% of centers, caregivers were observed modeling healthy dietary behaviors (eg, sitting with or eating same foods as children), but at fewer centers they were observed consuming unhealthy foods (eg, fast foods, salty snacks: 25%; and sugar-sweetened beverages: 50%). Although no substantial associations were observed between caregiver behaviors and center policies, effect size estimates suggest differences that may be of clinical significance. For example, caregivers were observed modeling healthy dietary behaviors more frequently at centers that had written policies about staff discouraging unhealthy foods for meals/snacks and having informal nutrition talks with children at meals. However, caregivers were observed consuming unhealthy foods and sugar-sweetened beverages more often at centers with policies that promoted healthier foods for meals/snacks. Future research should build on this study by using larger samples to understand why healthy food policies in child-care centers may not translate to eating practices among caregivers.

Awareness of the Fruits and Veggies-More Matters campaign, knowledge of the fruit and vegetable recommendation, and fruit and vegetable intake of adults in the 2007 Food Attitudes and Behaviors (FAB) Survey.

Increased consumption of fruits and vegetables is recommended to reduce chronic disease risk. Few studies have examined awareness of the current fruit and vegetable campaign in the United States, Fruits and Veggies-More Matters. This study assessed awareness of the Fruits and Veggies-More Matters campaign and knowledge of the 7-13 serving recommendation for fruit and vegetable consumption among adults, and determined whether these were associated with fruit and vegetable intake. Cross-sectional data from 3021 adults in the United States' National Cancer Institute's 2007 Food Attitudes and Behaviors Survey were analyzed. Few participants were aware of the Fruits and Veggies-More Matters campaign (2%) and the 7-13 recommendation (6%) for adults. More participants were aware of the former 5 A Day campaign (29%) and recommendation (30%). Thirty-nine percent reported consuming ≥5 servings of fruits and vegetables daily. Participants were more likely to consume ≥5 servings of fruits and vegetables/day if they were aware of the 5 A Day/Fruits and Veggies-More Matters campaign, and reported that the recommendation for adults was ≥5 servings/day. Findings suggest the need to increase awareness of the Fruits and Veggies-More Matters campaign, and the 7-13 recommendation among adults to support high fruit and vegetable intake.